The debate on FSSA’s privatization of Indiana Medicaid application and eligibility is generating a lot of heat as the program details are revealed and an implementation appears imminent. 

Positions have predictably hardened around two distinct poles.  Privatization is either good for the taxpayers of Indiana who pay to fund and manage the programs, or it’s a profit-driven nightmare for the poor and disabled Hoosiers who depend on Medicaid to preserve at least a measure of good health. 

Of course those favoring privatization are pointing to multiple inefficiencies in the current system (that’s because there are many) and will play the technology card as the trump.  “No one can squeeze out inefficiencies like a tech-savvy, profit-driven business” they’re saying.  And you know what, they’re partly right.

On the other side, state employee representatives, some legislators, and various protectors of the poor and disabled are demonizing the profit-seeking orientation of the vendor, as well as the recent reports documenting the failures of privatization efforts in other states.  “See, that proves it.”  Well, yes and no.

Finding the common ground

There is agreement on all sides that an overworked caseworker is an ineffective caseworker.  So dividing up the work and supporting the staff with better technology is a no-brainer.  So is keeping offices open in each county.  The Internet and the telephone are great tools, but this population simply doesn’t have predictable access to, or the necessary comfort with, these systems. 

So the IBM group deserves a fair chance to fix what is clearly not working, and to continue what is.  Most jobs appear to be secure, and the state might pick up a few more.  The things we know so far look good.  What we don’t know yet is what concerns me.

We’ve heard a lot about the savings and the efficiencies, and the Governor has said the IBM group will be closely watched and evaluated.  We expect that.  The question is what are they watching for?

We hope that a passing grade is not solely dependent on a ruthlessly efficient delivery model.  After all, the best performing businesses excel not by squeezing nickels, but by innovating better ideas.  And as the opponents of the plan cast their own judgments, we hope they can remain connected with their core reason for existence: advocacy. 

Advocacy is a two way street

Genuine advocacy acknowledges that the vendor should make a fair profit if their solutions are truly innovative and successful in the eyes of their customers.  And their customers are not the taxpayers, or the Governor, but the people who qualify for the services.  An advocacy mindset also acknowledges that Medicaid recipients deserve a level of service and functionality that preserves not only their health, but also their dignity. 

The good news is this kind of broad-view advocacy also creates a scenario where Indiana taxpayers still get more for their money and also reap the long-term benefits of healthier communities.

As advocates, we hope that the program includes true customer-oriented processes, and evaluates their customers’ experiences just like it was, well, a business. 

And we urge Hoosiers who depend on Medicaid, and the others involved in the program, to realize that in these swiftly moving times, they’re expected to move some too -- Medicaid is an entitlement program, but that doesn’t mean they’re entitled to hold their foot on the brakes.

ClaimAid has been in on this two-way street of advocacy for nearly two decades.  We’ve grown, and made a profit.  We’ve also organized our entire organization around exceptional service to the people we’re hired to help, which includes both the people paying the invoice and the people seeking Medicaid assistance.  This is advocacy in its fullest sense, and a most satisfying business to be in.  It’s the right thing, and it’s good business.

Steve Cooper is the President of ClaimAid